Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $61.66 / $61.66 / $61.66	Facility	TC	$61.66	$61.66	$61.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $58.88 / $141.25	Professional		$40.74	$58.88	$141.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $30.90 / $194.98	Professional	26	$15.85	$30.90	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.11 / $169.82	Professional	TC	$23.99	$33.11	$169.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $61.66 / $89.13	Professional		$31.62	$61.66	$89.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $17.78 / $31.62	Professional	26	$12.59	$17.78	$31.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $19.95 / $33.11	Professional	TC	$18.62	$19.95	$33.11
BCBS Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $36.31 / $36.31	Facility		$36.31	$36.31	$36.31
BCBS Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $36.31 / $91.20	Professional		$14.45	$36.31	$91.20
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $79.43 / $147.91	Professional		$43.65	$79.43	$147.91
Christus Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $63.10 / $63.10	Facility		$43.65	$63.10	$63.10
Christus Facility/Professional Facility Modifier TC Low / Median / High Price $36.31 / $38.02 / $38.02	Facility	TC	$36.31	$38.02	$38.02
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $25.70 / $25.70	Professional	26	$25.12	$25.70	$25.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $51.29 / $147.91	Professional		$32.36	$51.29	$147.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $28.18 / $74.13	Professional	26	$13.18	$28.18	$74.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $25.70 / $75.86	Professional	TC	$18.62	$25.70	$75.86
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $416.87 / $416.87 / $416.87	Facility		$416.87	$416.87	$416.87
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $234.42 / $234.42 / $234.42	Facility	26	$234.42	$234.42	$234.42
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $251.19 / $251.19 / $251.19	Facility	TC	$251.19	$251.19	$251.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $645.65 / $645.65	Professional		$194.98	$645.65	$645.65
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $512.86 / $512.86 / $512.86	Professional	26	$512.86	$512.86	$512.86
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $346.74 / $346.74	Professional	TC	$323.59	$346.74	$346.74
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $95.50 / $186.21	Facility		$56.23	$95.50	$186.21
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $74.13 / $144.54	Professional		$39.81	$74.13	$144.54
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $32.36 / $104.71	Professional	26	$15.85	$32.36	$104.71
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $42.66 / $81.28	Professional	TC	$23.99	$42.66	$81.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $33.11 / $57.54	Professional		$24.55	$33.11	$57.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $64.57 / $138.04	Professional		$27.54	$64.57	$138.04
Providence Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $95.50 / $194.98	Facility		$48.98	$95.50	$194.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $51.29 / $173.78	Professional		$32.36	$51.29	$173.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $27.54 / $69.18	Professional	26	$13.18	$27.54	$69.18
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $25.70 / $72.44	Professional	TC	$18.20	$25.70	$72.44
United Facility/Professional Facility Modifier Low / Median / High Price $21.88 / $33.11 / $54.95	Facility		$21.88	$33.11	$54.95
United Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $61.66 / $158.49	Professional		$40.74	$61.66	$158.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $28.84 / $69.18	Professional	26	$17.38	$28.84	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $30.20 / $87.10	Professional	TC	$23.99	$30.20	$87.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $26.92 / $66.07	Professional		$26.92	$26.92	$66.07
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $11.22 / $26.30	Professional	26	$11.22	$11.22	$26.30
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $15.49 / $38.90	Professional	TC	$15.49	$15.49	$38.90